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ATI Fundamentals Retake Exam Questions with Verified Solutions Graded A

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Which of the following is the most important step for the nurse to take when caring for a client with a wound infection? A. Apply an antibiotic ointment to the wound. B. Use sterile technique during dressing changes. C. Change the wound dressing once a day. D. Keep the wound open to air. B. ...

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  • October 21, 2024
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  • 2024/2025
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ATI Fundamentals Retake



ATI Fundamentals Retake Exam Questions with
Verified Solutions Graded A 2024-2025

Which of the following is the most important step for the nurse to take when caring
for a client with a wound infection?

A. Apply an antibiotic ointment to the wound.
B. Use sterile technique during dressing changes.
C. Change the wound dressing once a day.
D. Keep the wound open to air.
B. Use sterile technique during dressing changes.


Rationale: Using sterile technique helps prevent further contamination and spread
of the infection.
A nurse is caring for a client who has a prescription for wound irrigation. Which of
the following actions should the nurse take?

A. Cleanse the wound from the most contaminated area to the least contaminated
area.
B. Use a 30-mL syringe to irrigate the wound.
C. Hold the syringe 1 inch above the wound.
D. Warm the irrigation solution to body temperature.
D. Warm the irrigation solution to body temperature.


Rationale: Warming the irrigation solution to body temperature helps to promote
comfort and healing. Cleaning should be done from the least to the most
contaminated area to prevent the spread of microorganisms.
A nurse is teaching a client who has a new diagnosis of diabetes mellitus about
how to manage hypoglycemia. Which of the following instructions should the
nurse include?

A. Administer a dose of glucagon IM if unable to swallow.


ATI Fundamentals Retake

,ATI Fundamentals Retake


B. Drink 240 mL (8 oz) of milk at the first sign of hypoglycemia.
C. Take an extra dose of insulin before strenuous exercise.
D. Avoid eating carbohydrates in the evening.
A. Administer a dose of glucagon IM if unable to swallow.


Rationale: Administering glucagon IM is appropriate if the client is unable to
swallow due to hypoglycemia. Consuming simple carbohydrates like milk is useful
for managing early signs of hypoglycemia, but more concentrated forms of glucose
are often preferred.
A nurse is performing a physical assessment of a client's peripheral vascular
system. Which of the following findings should the nurse expect?

A. Capillary refill time of less than 3 seconds
B. Presence of pitting edema
C. Warm skin with rapid capillary refill
D. Cyanosis of the nail beds
A. Capillary refill time of less than 3 seconds.


A capillary refill time of less than 3 seconds indicates good blood flow to the
extremities. Pitting edema, warm skin with rapid refill, and cyanosis can indicate
underlying vascular or circulatory issues.
A nurse is preparing to administer a medication to a client and notes that the
dosage is higher than the recommended range. Which of the following actions
should the nurse take?

A. Administer the medication as prescribed.
B. Notify the pharmacist about the discrepancy.
C. Clarify the prescription with the provider.
D. Ask another nurse to administer the medication.
C. Clarify the prescription with the provider.


The nurse should clarify the prescription with the provider to ensure client safety.

ATI Fundamentals Retake

,ATI Fundamentals Retake


Administering a dosage outside the recommended range could result in adverse
effects.
A nurse is teaching a client who is postoperative how to use an incentive
spirometer. Which of the following instructions should the nurse include?

A. Exhale fully before placing the mouthpiece in your mouth.
B. Hold your breath for at least 3 seconds after using the spirometer.
C. Inhale deeply and quickly through the mouthpiece.
D. Use the spirometer every 2 to 3 hours while awake.
D. Use the spirometer every 2 to 3 hours while awake.


Using the spirometer every 2 to 3 hours while awake helps to prevent postoperative
complications such as atelectasis. The client should inhale slowly and deeply
through the mouthpiece, hold the breath briefly, and then exhale slowly.
A nurse is caring for a client who requires an NG tube for gastric decompression.
Which of the following actions should the nurse take to ensure proper placement?

A. Aspirate gastric contents to verify pH levels.
B. Measure the tube from the nose to the earlobe to the xiphoid process.
C. Secure the tube to the client's cheek with tape.
D. Inject 30 mL of air and listen for gurgling over the abdomen.
A. Aspirate gastric contents to verify pH levels.


Aspirating gastric contents and checking the pH level helps confirm the NG tube is
in the stomach. The correct placement should show a pH of 4 or less.
A nurse is educating a client about managing their new colostomy. Which
statement indicates the client needs further teaching?

A. "I will change the pouch every 3-7 days."
B. "I can use deodorants in the pouch to manage odor."
C. "I should avoid high-fiber foods to prevent blockage."
D. "I will rinse the used pouch with hot water."


ATI Fundamentals Retake

, ATI Fundamentals Retake


D. "I will rinse the used pouch with hot water."


The client should rinse the pouch with lukewarm water, not hot water, to avoid
damaging the pouch material. The other statements indicate correct understanding.
A nurse is performing an assessment on a client who has hypokalemia. Which of
the following clinical manifestations should the nurse expect to find?

A. Hypertension
B. Positive Chvostek's sign
C. Constipation
D. Decreased deep tendon reflexes
C. Constipation


Rationale: Hypokalemia can cause decreased bowel motility, leading to
constipation. Positive Chvostek's sign is associated with hypocalcemia, and
decreased deep tendon reflexes are also a sign of hypokalemia.
A nurse is caring for a client with a pressure ulcer on the sacrum that is covered
with eschar. Which of the following actions should the nurse take?

A. Apply a hydrocolloid dressing.
B. Debride the wound to remove the eschar.
C. Leave the eschar intact.
D. Apply an enzymatic agent to debride the wound.
C. Leave the eschar intact.


Rationale: Eschar should be left intact if it is dry and stable, as it serves as a natural
barrier to infection. Debridement is necessary only if there is evidence of infection
or the eschar is moist and unstable.
A nurse is providing instructions to a client who is at risk for developing
osteoporosis. Which of the following statements by the client indicates an
understanding of the teaching?


ATI Fundamentals Retake

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